Department of Radiology Queen Alexandra Hospital Portsmouth Hospitals NHS Trust 18th BSGAR Annual Meeting 35 February 2016 Birmingham Authors Dr A Higginson Consultant GI Radiologist ID: 914313
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Slide1
Unexplained anaemiaan unusual case report
Department of RadiologyQueen Alexandra HospitalPortsmouth Hospitals NHS Trust
18th
BSGAR Annual
Meeting
3-5
February
2016
Birmingham
Slide2AuthorsDr A. Higginson, Consultant GI RadiologistEmail: Antony.Higginson@porthosp.nhs.uk
Dr R. Beable, Consultant GI Radiologist Email: Richard.Beable@porthosp.nhs.uk
Dr A. Yazdi,
Consultant GI
Radiologist
Email:
Amir.Yazdi@porthosp.nhs.uk
Slide3Clinical presentation59 year old female
Presents with fatigue, anaemia, weight loss and ? hematemesis.LAB: Routine: unremarkable.Ferritin: 588 (12-250).OGD: Vascular ectasia, patchy erythema → ? gastric antral
vascular
ectasia
.
GAVE-Syndrome (watermelon stomach):
Rare, unknown pathogenesis.
Anaemia, GI bleed and abdominal pain.
Associated with variety of conditions (hepatic, renal, cardiac).
Resembles portal hypertensive
gastropathy
.
Slide4OGDWill follow
Slide5CTWill follow
Slide6CT findingsDiffuse nodular infiltration of omentum
with calcifications.Retroperitoneal deposit (left ureter).No ascites.Small pulmonary nodules.
Slide7Additional clueSerum
free lambda chain: 119 (6-26)
Slide8DiagnosisPathology
(16G core omentum):Widespread eosinophilic deposition in vessel walls & interstitium.Diffuse histiocytic
infiltrates.
Focal calcifications & ossification.
Congo red stain + birefringence: strongly positive.
→ characteristic of
amyloidosis
.
US
image Will follow
Slide9Discussion
Amyloidosis:Systemic vs. localized deposition of amyloid.Primary: associated with myeloma, lymphoma.Secondary: associated with RA, TB, Crohn.GI (most commonly), but also GU, cardiovascular,
msk
and CNS.
GI:
Gastro-oesophageal:
dysmotility
, reflux, wall thickening (amyloid in
muscularis
,
Auerbach
plexus)
Small bowel: diffuse or nodular wall thickening.
Splenomegaly, with ↑ risk of spontaneous rupture.
Hepatomegaly, with ↓ attenuation (amyloid deposition).
Peritoneum &
Omentum
: diffuse nodules, +/- calcifications.
Can mimic disseminated malignancy, but has indolent clinical course.
Slide10Take home messageClinical and imaging features of amyloidosis are non-specific and diverse.
Amyloidosis in DD. Unexplained weight loss, GI bleeding.History of chronic inflammatory disease, myeloma.Can mimic peritoneal carcinomatosis, but indolent course.
Slide11References
Omental and Peritoneal Involvement in Systemic Amyloidosis: CT with Pathologic Correlation. Horger
et al. doi:10.2214/AJR.05.0638.
Unusual
Nonneoplastic
Peritoneal
and
Subperitoneal
Conditions: CT findings.
Pickhardt
et al.
doi
110.1148/rg.253045145.
Amyloidosis of the gastrointestinal tract: a 13-year,
single-
center
, referral experience.
Cowan et al. doi:10.3324/haematol.2012.068155.
Amyloidosis:
Review and
CT
Manifestations.
Georgiades
et al.
d
oi
10.1148/rg.242035114